The scandal of low pay in the NHS, 24 September 2013

by Rachael Maskell, head of Health

Low pay in the NHS is a scandal that affects both staff and patients, but could be easily addressed.

With the cost of living rising for all, this month Unite is calling on the government to introduce the Living Wage across the NHS. Unite, which represents 100,000 health workers, enters negotiations with the NHS Pay Review Board this month. It will also be calling for an end to differential pay increases which worsen inequality year on year - a one per cent pay increase means the lowest paid get a mere £142 - and for historic wage differentials to be addressed.

Introducing the Living Wage would cost the Treasury as little as £5m - compared to the £3 billion the government has just spent on an unwanted and unnecessary restructuring of the NHS.

11 Downing Street’s ideologically-driven 2 year wage freeze, followed by a below cost-of-living 1% uplift for the foreseeable future, means NHS wages are now falling behind their equivalents in the private sector.

NHS workers are hit as hard as anyone by the steep rise in fuel, food, utilities, housing, clothes, and other essentials.

But some are now losing between a quarter and a third of their income. Some now even depend on foodbanks to feed their families, according to Unite’s research.

How an employer can expect staff to deliver high quality care when they are not able to put food on their own kitchen table?

Cuts are hitting staff across the board, with some of the lowest paid workers being the hardest hit. Skilled workers providing vital hospital maintenance and caring for patients have lost up to £3277 recruitment and retention premium. Even as the government says it wants to extend 24/7 working in the NHS, those working unsocial hours are losing up to £10,000 from on call changes. Our paramedics can now lose up to a quarter of their income if they are off sick.

The annual staff survey reveals that staff are no longer recommending others work in the NHS.

As the largest employer in most counties, restricting the pay of NHS staff also hits local economies hard.

The Treasury must restore the independence of the NHS Pay Review Body and allow it to examine the true cost of living. The NHS should be genuinely free to use this evidence to negotiate on national pay with unions - not have a freeze imposed from above.

NHS employers complicity with the government’s austerity programme hurts both staff and patients.

Right now, NHS hospitals and Trusts are engaged in mass programmes to downgrade staff to cut their staff spend.

Increasingly, they are restricting staff progression as an opportunity to save money. Under the guise of objectively assessing the skills required for a job, job evaluations are used as an excuse to ‘downgrade’ or ‘downband’ staff - bumping them down a whole pay grade. One in ten Unite members report such downbanding, with staff are losing thousands of pounds as a result.

Why should patients care? Staff who have been ‘downbanded’ don’t automatically lose their advanced professional skills and knowledge. NHS employers may assume that patients will still get the higher level of skills delivered, on the cheap.

But in fact staff will put their professional registration at risk if they perform above the competencies for the post. And when they leave, they will be replaced by someone with a far lower skill and knowledge base, worsening the quality of patient care. Departmental re-organisations should be based on requirements needed to deliver a job to maximise the quality of care and safety of patients, not on how much you can salami slice pay.

Performance pay has been another recent and unwanted development in the NHS. It is open to favouritism and discrimination. It is used as a means of control and bullying.

It demoralises staff and makes it harder to question a manager’s judgement or to safely whistleblow to expose poor practice where necessary. Performance pay focuses staff on the targets that will be used to assess their performance - not on providing a holistic service to patients. It is simply not safe, and patients and staff will be exposed to greater risk.

Unite are constantly raising issues of pay justice and fairness with employers. But if the government was serious about delivering joined up and co-ordinated services, they would first stop the blight of low pay and pay inequality across the service.

Next year, the national NHS pay agreement, Agenda for Change, will be 10 years old. It is the biggest equality proofed pay system probably anywhere in the world. It has remained flexible enough to address local recruitment and retention issues and to allow staff to progress as their skills and experience develops. It could be fit for purpose for at least another decade.

But it is time the Treasury sat down with Unite and other health unions to really hear the truth on NHS pay and put an end to regressive pay agendas. It is obscene when people working in the NHS, performing the most vital tasks of caring for the people we love most, take home less than a tenth of senior managers.